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Serpil Dizbay Sak
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P1.15 - Thymoma/Other Thoracic Malignancies (ID 184)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.15-12 - A Different Aspect to Tumor Size Dilemma in Thymoma's TNM Staging Classification (Now Available) (ID 1827)
09:45 - 18:00 | Author(s): Serpil Dizbay Sak
- Abstract
Background
Thymic epithelial tumors including thymomas are relatively rare thoracic neoplasms; though thymomas are the most common tumors of anterior mediastinum in adults. Among the TNM classifications of many solid tumors, tumor size is included in definition of T descriptor and as a key for staging it plays an important role in predicting prognosis and affects clinical decision making. However, TNM or the other classifications of thymomas do not take tumor size into consideration.
Method
Between 2004 and 2018, 204 consecutive patients with thymic epithelial tumors underwent surgical resection in Department of Thoracic Surgery, Ankara University Medical School. One hundred and forty-three patients with thymoma were included in the study. When survival analysis was performed, sixteen cases were excluded due to missing datas of either survival and/or tumor diameter. Remaining 127 patients were classified into two groups: a. largest tumor diameter (LTD), b. mean tumor diameter (largest diameter+shortest diameter/2) (MTD). Then each were divided into three subgroups ( LTDa/ MTDa ≤5cm; LTDb/ MTDb 5.1-10 cm; LTDc/ MTDc >10 cm). LTDa, LTDb and LTDc subgroups contained 47 (37%), 60 (47.3%) and 20 (15.7%) patients; while MTDa, MTDb and MTDc subgroups had 66 (52%), 56 (44.1%) and 5 (3.9%) patients respectively.
Result
There were 78 males and 65 females, with a mean age of 49.6 years (10-78). Results of the survival analysis according LTD and MTD subgroups are shown in Table 1. In survival analysis, there were significant differences in the presence of MG, resection status (R0 vs R1), T status and the Masaoka-Koga staging (p=0.018, p=0.001, p=0.015, p = 0.003), respectively. In survival analysis for MTD subgroups, survival decreased as the tumour size increased. In LTD group, the only difference which was close to statistical significance was in R0 group for 10 years OS (p=0.051).
Table 1: 10-year survival according to tumor diameter groups
ConclusionLargest Tumor Diameter (LTD)
Mean Tumor Diameter* (MTD)
≤5cm
5.1-10cm
p value
≤5cm
5.1-10cm
p value
10 years overall survival (%)
(LTD:107(48/59) patients, MTD:122 (66/56))
87.6
80
0.246
91.2
74.8
0.088
10 years disease-free survival (%)
(LTD:94 (40/54) patients, MTD:107 (56/51))
75.5
56.5
0.113
82.6
41.9
0.052
10 years overall survival in R0 resection (%)
(LTD:91(37/54) patients, MTD:104 (53/51))
95.2
81.1
0.051
96.8
75.9
0.027
10 years disease-free survival in R0 resection (%)
(LTD:82 (34/48) patients, MTD:93 (48/45))
75.2
57.7
0.159
82.4
43.1
0.095
In this study, complete resection was the most powerful prognostic factor for thymoma as reported by Ruffini et al. Though complet resection is associated with better survival, tumor size is an essential factor on decision of complete resection. Therefore, the largest or mean tumor size should be a criterion in the thymoma TNM staging system.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-23 - The Role Adjuvant Chemotherapy in Resected Stage 1 NSCLC with High Risk Factors: A Turkish Oncology Group Study (Now Available) (ID 2301)
10:15 - 18:15 | Author(s): Serpil Dizbay Sak
- Abstract
Background
Adjuvant chemotherapy is accepted as a standard treatment for suitable patients who have undergone surgery for T2N0 non-small cell lung cancer with tumors larger than 4 cm. Despite similar relapse rates, the benefit of adjuvant chemotherapy for smaller tumors with high risk features is not clear. In this retrospective analysis our aim was to evaluate the prognostic impact of adjuvant platin-based chemotherapy in high-risk stage 1 NSCLC patients.
Method
This cooperative group study included 250 NSCLC patients who underwent curative surgery for stage 1 NSCLC with tumor size 2-4 cm and adverse prognostic factors consisting of visceral pleural invasion(VPI), lympho-vascular invasion(LVI), high grade, presence of solid-micropapillary(SMP) components or STAS. Records of patients were analyzed to investigate the prognostic impact of adjuvant chemotherapy in this cohort. DFS was defined as the time from surgery to the last follow-up, until relapse or death, CSS;time from surgery to death related to cancer or last known contact, OS;time from diagnosis to death or last known contact. Statistical analysis was performed using SPSS 20.0 software(SPSSInc,Chicago,USA).
Result
Median age at presentation was 63 years (range 18-90). The mean tumor size was 29.4 ± 7.4 mm. The frequency of patients with specified risk factors were: VPI: n: 92 (36.8%); LVI: n: 91 (36.4%); Grade 3:n: 49 (19,6%); SMP:n: 76 (30.4%); STAS:n: 15 (6%). A total of 51 patients had received adjuvant platin-based chemotherapy. There were significantly more patients who received chemotherapy in the younger age group (<65 ears old, ≥65 years old) and those with larger tumors (2 – 3 cm, 3 – 4 cm).
During a median follow-up period of 91.8 months; 79 patients(31.6%) experienced recurrence, 62 patients(24.8%) have died, 144 patients(57.6%) were alive without disease and 24 patients (9.6%) were alive with disease.
5-year and 10-year OS rates were 72.7%(± 3,5) and 46.8%(± 8), respectively. There was a significant improvement in DFS with adjuvant chemotherapy, especially in groups with VPI (93.3% vs 53.6%, p:0.016) and SMP (92.3% vs 57.3%, p:0.03). There was also a non-significant trend for improved CSS and OS among patients who received CT.
Table 1. Effects of chemothrapy on survival. Chemotherapy Group
Events/N Median 5-years DFSNon - treatment Group
Events/N Median 5-years DFSP Value DFS 12/51 NE % 74.9 ± 6.3 81/190 71.1 months % 54 ± 4.2 0,032* CSS 4/49 NE % 89 ± 5 41/179 91.8 months % 76.9 ± 3.8 0,078 OS 10/49 NE %77.4 ± 6.4 51/179 88.9 months % 72.1 ± 4 0,541 *All values are stratified, respecting to significant confounding factors such as age, gender and tumor size.
Conclusion
Adjuvant platin-based chemotherapy should be considered for this subset of patients having high grade tumors, or those with VPI, LVI or solid-micropapillary components. Prospective, randomized trials incorporating clinical and molecular risk factors are required to clarify the role of adjuvant chemotherapy for stage 1 NSCLC patients.
